Management Of Suspected Febrile Neutropenia
When indicated, antibiotics must be given within 60 minutes.
Antibiotics must not be delayed by waiting for FBC results to confirm neutropenia
Patient has received chemotherapy
within past 6 weeks?
No
Normal triage and management of sepsis
HIGH RISK
1. Intravenous fluid resuscitation
2. Critical care outreach team referral
3. Send urgent FBC, blood cultures, U&E
LFT, CRP, G&S. Do not wait for results.
4. If no allergies:
Piperacillin/tazobactam 4.5g IV
and gentamicin 5mg/kg IV§
+/- vancomycin 1g IV§ (MRSA+ or CV line)
4. If penicillin allergy*:
Meropenem 1g IV
+/- vancomycin 1g IV§ (MRSA+ or CV line)
5. Send MSU
No
Patient is not neutropenic
Oncology pt: contact acute oncology service
Haematology pt: contact on-call haematologist
No
Patient may not be septic
Oncology pt: contact acute oncology service
Haematology pt: contact on-call haematologist
Penicillin allergy*
Meropenem 1g IV +/- vancomycin 1g IV§ if
suspect central line or MRSA infection
Yes
Urgent observations
CEWS scoring
Record drug allergies
Clinical Early Warning Score
Process FBC immediately using ISTAT
Also send urgent U&E, LFT, CRP,
group & save, blood cultures, MSU
Neutrophils <1.0 ?
Yes
Pyrexia >38°C (or fever at home)?
or Patient Unwell
Yes
Weigh patient
Review drug allergies
No allergies
Piperacillin / tazobactam 4.5g IV
and gentamicin 5mg/kg IV§
+/- vancomycin 1g IV§ if
suspect central line or MRSA infection
Door to needle time = ______mins
Contact Acute Oncology Service
*This refers to previous skin reactions with penicillins. If previous anaphylaxis with penicillins, please contact on-call
microbiologist for advice before giving meropenem.
§Dose of gentamicin and vancomycin should be reduced if there is renal impairment. Gentamicin should be dosed on ideal
body weight if >20% obese. Please refer to trust anti-microbial guidelines.